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THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series

Disclosure: A. Halstrom: None. G.A. Dobri: None. Acromegaly is a rare disorder characterized by tumoral hypersecretion of growth hormone (GH) leading to overproduction of insulin-like growth factor 1 (IGF-1). Patients present with physical changes, and systemic complications. Treatment involves surg...

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Autores principales: Halstrom, Amanda, Dobri, Georgiana Alina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553422/
http://dx.doi.org/10.1210/jendso/bvad114.1108
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author Halstrom, Amanda
Dobri, Georgiana Alina
author_facet Halstrom, Amanda
Dobri, Georgiana Alina
author_sort Halstrom, Amanda
collection PubMed
description Disclosure: A. Halstrom: None. G.A. Dobri: None. Acromegaly is a rare disorder characterized by tumoral hypersecretion of growth hormone (GH) leading to overproduction of insulin-like growth factor 1 (IGF-1). Patients present with physical changes, and systemic complications. Treatment involves surgery and medical therapy with the goal of normalizing IGF-1. First line medical therapy consists of first-generation injectable somatostatin receptor ligands (SRL) (octreotide LAR, lanreotide autogel). Dopamine agonists (cabergoline) can be used in patients with mild IGF-1 elevation. If IGF-1 levels do not normalize, pasireotide or pegvisomant can be tried. Until recently, SRLs were administered only as a deep tissue injection. Patients have reported injection site reactions, frustration, and breakthrough acromegaly symptoms between doses. Two trials were conducted which showed that oral octreotide is an effective alternative for patients after achieving biochemical control with the injectable formulation. Two cases are presented below in which patients with acromegaly were treated with de novo oral octreotide either or as combination therapy with cabergoline, after a significant time lapse since injection SRL. Our first case is a 24 year old female with a 19mm mammosomatotroph adenoma, resected 8 years prior, with questionable remnant on postoperative MRI and biochemically active acromegaly. She was started on octreotide LAR 20mg which was titrated up to 30mg. However, she had not achieved biochemical control, with lowest IGF-1 543ng/mL (83-456ng/mL), Z-score 2.4, and GH 5.8ng/mL (<= 7.1ng/mL). She wanted a break from medical therapy and discontinued octreotide LAR. She was later started on pegvisomant 15mg but stopped after 10 days due to an allergic reaction and was switched to cabergoline. Cabergoline was up titrated to 3.5mg weekly, still without biochemical control, IGF-1 417ng/mL (103-326ng/mL), Z-score 2.5, GH 7.69ng/mL (0.05-8ng/mL), at which time oral octreotide 20mg twice daily was started and cabergoline decreased to 2.5mg weekly. Oral octreotide was increased to 60mg daily and IGF-1 levels normalized to 294ng/mL (83-456ng/mL), Z-score 1. The second case is a 70 year old female with type 2 diabetes, arthritis, left ventricular hypertrophy, obstructive sleep apnea and colon polyps found to have a 10mm pituitary adenoma with IGF-1 481ng/mL (32-238ng/mL), Z-score 3.1, GH 1.28ng/mL (0.05-8ng/mL). She declined surgical resection and opted for medical management. Oral octreotide 20mg twice daily was started and further increased to 60mg daily IGF-1 went as low as 327ng/mL (28-231ng/mL), Z-score 2.5 and GH 0.4ng/mL (0.05-8ng/mL). The dose was increased to 80 mg daily are lab results are pending. These are the first two published cases describing a novel approach to treating acromegaly in which patients were found to have a biochemical response to de novo oral octreotide either alone or combined with cabergoline. Presentation: Thursday, June 15, 2023
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spelling pubmed-105534222023-10-06 THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series Halstrom, Amanda Dobri, Georgiana Alina J Endocr Soc Neuroendocrinology And Pituitary Disclosure: A. Halstrom: None. G.A. Dobri: None. Acromegaly is a rare disorder characterized by tumoral hypersecretion of growth hormone (GH) leading to overproduction of insulin-like growth factor 1 (IGF-1). Patients present with physical changes, and systemic complications. Treatment involves surgery and medical therapy with the goal of normalizing IGF-1. First line medical therapy consists of first-generation injectable somatostatin receptor ligands (SRL) (octreotide LAR, lanreotide autogel). Dopamine agonists (cabergoline) can be used in patients with mild IGF-1 elevation. If IGF-1 levels do not normalize, pasireotide or pegvisomant can be tried. Until recently, SRLs were administered only as a deep tissue injection. Patients have reported injection site reactions, frustration, and breakthrough acromegaly symptoms between doses. Two trials were conducted which showed that oral octreotide is an effective alternative for patients after achieving biochemical control with the injectable formulation. Two cases are presented below in which patients with acromegaly were treated with de novo oral octreotide either or as combination therapy with cabergoline, after a significant time lapse since injection SRL. Our first case is a 24 year old female with a 19mm mammosomatotroph adenoma, resected 8 years prior, with questionable remnant on postoperative MRI and biochemically active acromegaly. She was started on octreotide LAR 20mg which was titrated up to 30mg. However, she had not achieved biochemical control, with lowest IGF-1 543ng/mL (83-456ng/mL), Z-score 2.4, and GH 5.8ng/mL (<= 7.1ng/mL). She wanted a break from medical therapy and discontinued octreotide LAR. She was later started on pegvisomant 15mg but stopped after 10 days due to an allergic reaction and was switched to cabergoline. Cabergoline was up titrated to 3.5mg weekly, still without biochemical control, IGF-1 417ng/mL (103-326ng/mL), Z-score 2.5, GH 7.69ng/mL (0.05-8ng/mL), at which time oral octreotide 20mg twice daily was started and cabergoline decreased to 2.5mg weekly. Oral octreotide was increased to 60mg daily and IGF-1 levels normalized to 294ng/mL (83-456ng/mL), Z-score 1. The second case is a 70 year old female with type 2 diabetes, arthritis, left ventricular hypertrophy, obstructive sleep apnea and colon polyps found to have a 10mm pituitary adenoma with IGF-1 481ng/mL (32-238ng/mL), Z-score 3.1, GH 1.28ng/mL (0.05-8ng/mL). She declined surgical resection and opted for medical management. Oral octreotide 20mg twice daily was started and further increased to 60mg daily IGF-1 went as low as 327ng/mL (28-231ng/mL), Z-score 2.5 and GH 0.4ng/mL (0.05-8ng/mL). The dose was increased to 80 mg daily are lab results are pending. These are the first two published cases describing a novel approach to treating acromegaly in which patients were found to have a biochemical response to de novo oral octreotide either alone or combined with cabergoline. Presentation: Thursday, June 15, 2023 Oxford University Press 2023-10-05 /pmc/articles/PMC10553422/ http://dx.doi.org/10.1210/jendso/bvad114.1108 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Neuroendocrinology And Pituitary
Halstrom, Amanda
Dobri, Georgiana Alina
THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title_full THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title_fullStr THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title_full_unstemmed THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title_short THU028 Novel Approach To Management Of Acromegaly With De Novo Oral Octreotide Or Combination Therapy With Cabergoline: A Case Series
title_sort thu028 novel approach to management of acromegaly with de novo oral octreotide or combination therapy with cabergoline: a case series
topic Neuroendocrinology And Pituitary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553422/
http://dx.doi.org/10.1210/jendso/bvad114.1108
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